Labour day primer: Your guide to giving birth

Is this labour?
You’ve been feeling contractions on and off for days. Today they seem more regular—and when you actually write down the times, you find they are showing up every six or seven minutes. Is this it?

“It’s not unusual to have one (or more) false starts,” says childbirth educator and doula Samantha Leeson. Here’s what to look for:

• Before or in early labour, you are likely to have loose bowel movements as your body gets ready.
• You may notice that the mucus plug has come away from the cervix, often tinged with blood (called a “bloody show”). This can happen a day or more before labour starts, or during early labour.
• The contractions are more than 45 seconds long, and are gradually getting stronger and closer together. Shorter contractions that don’t increase in intensity are more likely to mean false labour.

Think it might be just a practice round? Your partner can massage your lower belly and back to make you more comfortable. Try having a warm bath (perhaps with a glass of wine) to see if this will stop the contractions. If not, it will help you rest and relax.

Labour supply list• Snacks and drinks
• Music and CD player
• Warm socks: Feet tend to get cold in labour!
• Extra pillows
• Ice water and washcloth for a cool compress
• Tennis balls and rolling pin for firm pressure against your back
• Hot pack: Fill an old sock with two cups of uncooked rice and sew shut. Heat in the microwave.
• Exercise ball
• Plastic lawn chair for sitting in the shower

What happens during this stage
• Contractions usually start at about 20 minutes apart and gradually get closer together, until they’re about five minutes apart.
• Contractions last 30 to 45 seconds.
• The cervix thins out or “effaces.”
• The cervix begins to dilate and may be dilated three or four centimetres by the end of this stage.

Your goal for this stage
The goal in early labour is to relax and ignore it for as long as possible,” says childbirth educator Michele Sears. “I encourage couples to brainstorm before labour starts about what might work for them. Sometimes they pick a movie they’d like to see and buy the DVD in advance.”

Strategies couples have used to distract themselves
• listening to music
• meditation
• going for a walk
• shopping
• doing light housework
• packing for the hospital
• baking a birthday cake for the baby

If you can, sleep or rest; this will help you have more energy later. Or take advantage of the pain-relieving effects of natural endorphins that are released when you laugh (so make that movie a comedy) or have sex (or at least some affectionate cuddling).

Generally, it’s a good idea to wait until you’re in active labour. “You’re looking for contractions that are four minutes apart and lasting at least 60 seconds, and that have been that way for at least an hour,” says childbirth educator Samantha Leeson. Going to the hospital too early can make labour seem longer, and the hospital environment may feel more stressful.

Some exceptions: if you live a long way from the hospital, or if the weather may make driving difficult, you may want to go sooner. If your membranes have ruptured, follow your doctor’s or midwife’s instructions. For a home birth, you may want to call the midwives a bit sooner, so they have time to get set up.

Doulas: More than holding handsCan a doula help you during labour? Cori Smithen of Saskatoon is convinced of the benefits: She found that even though she’d attended childbirth classes and read lots of books, once she was in labour, “it was like I forgot all that stuff!” Having a doula to remind her and support her made a big difference.

A doula will support your partner as well as you through labour and birth. Research has shown that having a doula significantly reduces your risk of having a Caesarean section and other medical interventions, shortens labour and increases the chances of breastfeeding success.

Intense contractions

What to expect
• Contractions are usually about five minutes apart at the beginning, and get as close as three minutes apart.
• Contractions last 45 to 60 seconds.
• The cervix thins out more and dilates to seven centimetres.

Your goal for this stage
“The contractions are becoming more painful during this stage, so your goal is to manage that pain,” says Sears.

Some coping stategies
Use waterSears suggests getting into a shower and letting the water run on your back or belly, or getting into a bath. Your partner may want to bring a bathing suit too.

Breathe slowly and rhythmicallyPartners can help by slowly counting each breath or saying “breathe in (long pause) breathe out.”

WalkStaying mobile has been shown to significantly reduce the length of labour and the need for pain medication. If your partner or doula walks with you, you’ll have someone to hold onto for support when the contraction starts. Leeson suggests that if you feel tired, lie down for 30 minutes, then get up and walk again.

Try different positionsWhen you don’t feel like walking anymore, try kneeling, hands and knees, squatting or lying on one side and then the other. As labour progresses, the baby moves further down into your pelvis, so the position that was most comfortable an hour ago may not be working now.

Massage can help — but the person doing it needs to pay attention to your responses What feels good at one point may be annoying at another stage. During active labour, massaging the lower back and shoulders is generally more helpful than massaging the belly. Your partner can use tennis balls or a rolling pin to apply pressure to the lower back. (Actually rolling the rolling pin on your back will probably be uncomfortable; rather, use it to apply firm, steady pressure.)

Drink lots of waterStay hydrated by sipping water after every two contractions, suggests Leeson. It’s also important to keep your bladder empty, so try to urinate every hour even if you aren’t feeling a strong urge.

Almost there

What happens during this stage
• Contractions may be two or three minutes apart, or may be right on top of each other, with little or no break.
• Contractions last 60 to 90 seconds.
• The cervix is completely thinned out and dilated to 10 centimetres.

Your goal for this stage
“Your goal is to maintain your confidence,” says Sears. Transition is an intense stage of labour. Many women experience nausea, shaking, chills and hot flashes. You are also likely to feel overwhelmed and ready to give up.

“This is when caring, positive support is so important,” Sears advises. Encouraging words (“You’re doing great; the baby will be here soon”) can really help.

Some coping strategies

Take it one contraction at a timeRest as much as possible between contractions, even if the breaks are only brief.

Reduce outside stimulationKeep the lights dimmed, and any music low and calming.

Keep your breathing slowPatterned breathing (for example, three short breaths followed by a longer, more forceful breath) can give you something to focus on.

Lean on your partnerTry slow dancing, or holding onto him or her and slowly bending your knees as contractions intensify. Your partner should brace himself and be prepared to support your weight in case your legs give way during a strong contraction.

Moan in a low voice, sing or repeat a particular phrase over and overSaying something like “I know I can do this” helps you feel confident too, but Leeson says even repeating your phone number can work.

Strong pressure against your lower backThis can help, but stroking or rubbing is usually not appreciated.

As the pushing stage approaches, some women begin feeling the urge to bear down and push even though the cervix is not completely open. If that happens, you can blow out—as though you are blowing out a candle—repeatedly during the peak of the contraction. You may also want to change positions, perhaps moving to hands and knees, or lying on your side so there is less pressure against the cervix.

Back labour

A baby whose face is towards your belly (posterior position) can cause extra pain in your back during and between contractions. Try getting onto hands and knees, sitting backwards on the toilet or chair, or leaning over a table or bed — any position that uses gravity to lessen the pressure against your spine. Or take a lawn chair into the shower and let the water run over your back. Firm pressure against your back can help too.

The actual birth

What happens during this stage
• Contractions may be further apart again—perhaps five or 10 minutes.
• The mother feels the urge to bear down and push with the contractions.
• The baby moves through the open cervix and vagina and is born.

Your goal for this stage
You’ll want to find the most comfortable and effective position for giving birth to your baby, Sears says. Brady Henderson, for example, originally tried squatting, but then moved onto her hands and knees. “Once I was in that position, I could push more effectively, and the baby came right away,” she recalls. Other options (and your choices may depend at least in part on your caregiver’s preferences) are standing (with support), semi-sitting, using a birthing stool, or lying on one side.

Your other goal is to relax and let the birth canal and perineum open up for the baby. To achieve this, try to
• Relax your abdominal muscles by putting one hand on your lower belly and pushing it out as you breathe in.
• Visualize everything opening up to let the baby out.
• Ask to have warm wet cloths applied to the perineum.
• Put your hand down to touch the baby’s head as it moves down. This can help you understand where to push (plus it’s an incredible feeling!). Or ask your caregiver to put his or her fingers just inside the vagina to create some pressure and help direct your pushing.
• Push in response to the contractions and your body’s signals. Hold your breath only as long as your body tells you to. Pushing will be more effective if you don’t make noise (but you can’t always help doing some grunting and groaning). Your partner may need to provide physical support—keeping you in a semi-sitting position, for example.

As the baby crowns—which means the largest part of the baby’s head is emerging — you may feel an intense burning sensation. This is normal, and is a signal to you to stop pushing (easier if you keep your breath flowing without holding it) so that the baby will be born more slowly and the risk of tearing is reduced. Very soon your baby’s body will slip right out and you can welcome your new son or daughter.

Medical interventions

While most births are straightforward, about one in four women will have their babies born by Caesarean section, and more than half will request some kind of pain medication (most commonly epidural anaesthesia during labour).

You may want to discuss the risks and benefits of any procedures with your doctor, midwife or childbirth educator, or do some research on your own, so you can make the decisions that are right for you and your baby. Keep in mind, though, that things can change during labour and your plans need to be flexible.

Partners may feel their support isn’t as important when medical interventions become necessary, but that isn’t so; by helping the mother feel less stressed and asking questions on her behalf, a partner makes a positive difference for both mother and baby.

Your baby is here!

While your attention is naturally consumed by getting to know this incredible little person, the birth process isn’t quite complete. The cord that connected your baby to the placenta before birth needs to be cut; new Canadian research shows that delaying this for two minutes will reduce the risk of the baby’s iron levels being low later in the first year, so it’s worth waiting. (Your partner, if interested, can be the one who cuts the cord.) Then you’ll feel more contractions—a little milder now—as the placenta separates from the uterus and emerges.

If everything has gone well, ask to have your baby skin to skin, perhaps with a blanket to cover both of you; this helps stabilize your baby’s temperature and prepares you and baby to begin breastfeeding.

Whether labour has gone just as you expected, or things turned out not quite as planned, this is a day you will never forget—the day your baby was born.

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